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Second national scorecard on US health care system finds no overall improvement
Date:7/16/2008

ed or underinsured. Poor access pulls down quality and drives up costs of care. The U.S. leads the world on health care spendingwe should expect a far better return on our investment."

Wide Variability in Quality and Evidence of Inefficient Care

In addition to scoring poorly on indicators compared to other countries, performance varies greatly from state to state, region to region, and across hospitals and health plans. While the top tier of the U.S. system achieves excellence in some areas, the uneven performance across the country indicates a need for major improvement. Rates at the bottom of the distribution are often well below the leaders and the national averagewith as much as a fivefold spread between top and bottom rates.

The scorecard shows substantial gaps between national averages and benchmarks of higher performance across a broad array of quality and efficiency indicators. Efficiency performance remains especially low with a score of 53 out of 100, in part because of widespread delivery of inappropriate and wasteful care throughout the U.S., including potentially avoidable hospital admissions, minimal use of information technology, and high insurance administrative costs.

What Receives Attention Gets Improved

Even though the report finds that the health care system often lost ground or failed to improve, there is also evidence that focusing on specific areas through national initiatives can yield substantial improvement. For example, hospital standardized mortality ratios, a key indicator of patient safety, improved by 19 percent over five years, following broad public and private efforts to assess and improve hospital safety. Chronic care and acute hospital care quality metrics that have been the focus of public reporting, pay for performance, and improvement efforts also showed significant progress. Improvement in some quality metrics was offset by an increase in visits for adverse drug ef
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Contact: Mary Mahon
mm@cmwf.org
212-606-3853
Commonwealth Fund
Source:Eurekalert

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